Source: Parker RB, Cavallari LH.
Systolic Heart Failure. In: DiPiro JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM, eds. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7970780.
Accessed June 29, 2012.
- Congestive heart failure (CHF)
- Reduced myocardial contractility that results in inability
of heart to pump sufficient blood to meet body’s metabolic
- Reduction in muscle mass (e.g., myocardial infarction [MI])
- Dilated cardiomyopathies
- Ventricular hypertrophy caused by pressure overload (e.g.,
systemic or pulmonary hypertension, aortic or pulmonic valve stenosis)
or volume overload (e.g., valvular regurgitation, shunts, high-output
- Neurohormonal model:
- An initiating event
(e.g., acute MI) leads to decreased cardiac output.
- HF progression is mediated largely by neurohormones and autocrine/paracrine
- Angiotensin II
- Natriuretic peptides
- Arginine vasopressin
- Endothelin peptides
- Proinflammatory cytokines such as tumor necrosis factor α and
- Nearly 6 million Americans have HF and 670,000 new cases
are diagnosed each year.
- Incidence doubles with each decade of life and affects nearly
10% of individuals over age 75.
- Prevention involves identifying and modifying risk factors
- Coronary artery disease
- Chronic kidney disease
- Dyspnea on exertion
- Exercise intolerance
- Paroxysmal nocturnal dyspnea
- S3 gallop
- Cool extremities
- Cheyne–Stokes respiration
- Narrow pulse pressure
- Peripheral edema
- Jugular venous distention
- Hepatojugular reflux
Means of Confirmation
- Consider HF diagnosis in patients with characteristic
signs and symptoms; perform medical history and physical examination
with appropriate laboratory testing.
- New York Heart Association Functional Classification System
- I: No limitation of physical activity
- II: Slight limitation of physical activity
- III: Marked limitation of physical activity
- IV: Unable to carry on physical activity without discomfort
- American College of Cardiology/American Heart Association
(ACC/AHA) staging system
- Stage A: At high
risk for developing heart failure
- Stage B: Structural heart disease but no HF signs or symptoms
- Stage C: Structural heart disease and previous or current
- Stage D: Refractory HF (symptoms at rest despite maximal medical
- Complete blood cell count (CBC)
- Serum electrolytes (including calcium and magnesium)
- Renal, hepatic, and thyroid function tests
- Fasting lipid profile
- B-type natriuretic peptide (BNP)
- Ventricular hypertrophy on chest radiograph or electrocardiogram
- Chest radiograph may show pleural effusions or pulmonary edema.
- Echocardiogram to identify abnormalities of pericardium, myocardium,
or heart values and quantify left ventricular ejection fraction
- Improve quality of life.
- Relieve or reduce symptoms.
- Prevent or minimize hospitalizations.
- Slow disease progression.
- Prolong survival.
- Identify and treat underlying causes or precipitating
- ACC/AHA stage A
- Identify and modify
risk factors to prevent structural heart disease and subsequent
- Use angiotensin-converting ...